A new role for the endocrine nurse within a multidisciplinary approach to neuroendocrine tumours

SE Stewart

A new role for the endocrine nurse within a multidisciplinary approach to neuro-endocrine tumours.Historically patients with neuroendocrine tumours have been looked after either by the gastrointestinal team, the oncologists or the endocrinologists. Here, we demonstrate the need for a multidisciplinary approach to managing these rare tumours and a new role for the endocrine nurse.Our newly evolved, multi-disciplinary neuroendocrine tumour (NET) clinic comprises an endocrinologist, liver surgeon and an endocrine nurse (with the addition of an oncologist soon). MT was referred with a history of chronic upper abdominal symptoms, with recent acute episodes accompanied by diarrhoea. A large abdominal mass was present. Gut hormone screening confirmed the patient had Zollinger-Ellison syndrome, a rare neuroendocrine disorder presenting with a gastrinoma. Multiple liver metastases were confirmed with no obvious primary.Surgical resection was not possible and attempts were made to inhibit symptoms of gastrin hypersecretion with somatostatin analogues. The patient continued to deteriorate and the oncologist instigated conventional chemotherapy. Unfortunately, MT's condition worsened and he died.For optimum treatment of this rare tumour the patient needed frequent reviews by a range of specialists. Through the setting of this joint clinic we were able to provide this patient with the best alternatives for treatment at every step of disease progression despite the outcome. Instant communication was the key factor.This provides a new challenge for the endocrine nurse within this specific clinic. It is essential to provide information and support for both sufferers of these highly specialised conditions and their carers. MT and his wife could contact us directly and assistance was asked for and provided many times. Assimilating more information about these rare neuroendocrine tumours will improve our treatment of patients in the future and hopefully this multidisciplinary clinic will go from strength to strength.